Healthcare Provider Details

I. General information

NPI: 1710401773
Provider Name (Legal Business Name): SHARI CUPPLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 W 9TH ST
SULPHUR OK
73086-4619
US

IV. Provider business mailing address

1021 W 9TH ST
SULPHUR OK
73086-4619
US

V. Phone/Fax

Practice location:
  • Phone: 580-622-2061
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: